Campylobacter fetus subspecies fetusによる髄膜炎に両側硬膜下膿瘍を併発した1例

A Case of Bilateral Subdural Empyema Complicating Campylobacter Fetus Subspecies Fetus Meningitis

はじめに

　Campylobacter species(sp.）は微好気性のらせん状をしたグラム陰性桿菌である。人畜共通感染症を引き起こす菌であり，なかでもCampylobacter jejuniによる腸炎がよく知られている。しかし，ヒトの中枢神経領域の感染ではCampylobacter fetus subspecies fetus（以下，C. fetus）による髄膜炎が重要である^1）。今回，われわれはC. fetusによる髄膜炎の経過中に両側硬膜下膿瘍を併発したが，早期の菌同定を基にした抗生剤投与，穿頭ドレナージ術にて良好な経過を得られた症例を経験したので報告する。

Abstract

　Campylobacter fetus subspecies fetus (C. fetus) is a relatively rare cause of meningitis, with only 3 cases of C. fetus subdural empyema reported to date.　We experienced a case of bilateral subdural empyema complicating C. fetus meningitis.　A 51-year-old man was found lying unconscious on a street and was brought to the hospital in an ambulance.　He had no past history of any underlying disease but he had suffered head trauma approximately 1 month prior to this episode.　On admission, he had high fever and developed a convulsion fit.　Because the cerebrospinal fluid (CSF) findings showed mononuclear dominant pleocytosis and Gram staining revealed spiral-shaped gram negative bacilli, meningitis caused by C. fetus was suspected.　Brain CT preformed on admission did not reveal any obvious abnormality.　He was immediately treated with antibiotics effective against C. fetus.　His disease was complicated by bilateral subdural empyema; therefore, bilateral burr hole drainage was performed.　Durling the operation, a hematoma with an outer membrane and containing yellowish pus was revealed.　Infection of a chronic subdural hematoma and consequent formation of subdural empyema was deduced.　Eventually, C. fetus was isolated from the CSF arterial blood and subdural empyema.　The patient was discharged with no complication after the completion of the treatment.